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I Love My Doctor, But...!

June 14, 2009
by Mark Hagland
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I recently had a routine patient visit with my primary care physician. He's a great guy, and I've known him for many years. He's also a very good clinician, and I respect his knowledge and opinions. However...! I do find his opinions on EMRs quite frustrating. To begin with, he is an absolutely perfect candidate for an EMR; he has a two-site practice with locations in two different places on Chicago's North Side (several miles from one another), and patients who see him in both (including me). He is also affiliated with a large, integrated health system that presumably is beginning to automate its affiliated physician practices, though my doctor and I didn't have a chance to talk about that during my most recent visit. But when we discussed EMRs a year ago, my physician was highly dismissive of EMRs, a stance I had found quite shocking, really. For one thing, my doctor is my age--under 50; and he uses electronics and online communications in his personal life. And he certainly has every reason to move towards an EMR, in his two-physician, two-location practice, and in order to connect electronically with the health system with which he is affiliated. But his attitude, as expressed in our conversation a year ago, was essentially, "I won't do this unless they make it free and someone else handles pretty much handles every aspect of the implementation for me." For an under-50, otherwise "hip" physician, I was struck by the short-sightedness and lack of systems thinking my own personal physician expressed regarding EMRs--and he knows what I do and how much time and energy I put into writing about clinical automation and health information technology in my work. Still, my primary care physician's attitude is instructive, I think, as we try to move forward as a healthcare system. Contrary to what some might think (and also contrary to the mental image I tend to have in my head), it's not just the oldest, most technology-averse physicians who remain wary of the EMR journey; some middle-aged (I would posit that few under-35 MDs are likely in this category, but even there, I can't be 100-percent certain) doctors who are otherwise enlightened continue to resist EMR implementation on a combination of economic, hassle, and other grounds. So as CIOs and their teams in hospitals and integrated health systems try to move their organizations and broader affiliated enterprises forward on EMR/EHR, we're going to have to keep in mind that the level of conceptual consensus on automation that we tend to want to assume day-to-day, may not in fact yet fully exist. And we'll all have to figure out smart, savvy ways to bring along doctors like my own personal physician, who don't yet "get it."



There are few doctors who once they use an EHR (even the "bad" systems), and see the importance of having all the information at their fingertips 24/7, that would ever go back to the caveman days of paper. The key is universal adoption and communication among the systems. The world, not just the US, needs universal electronic medical digitization. The sooner the better.

Mr. Poggio and Dr. Budman, thank you both for your comments. Mr. Poggio, per the contrasting (and perhaps ironic) situations with your GP and your specialist, I agree with your underlying point, which is that simply having an EMR doesn't guarantee good service or intelligent practice management. Dr. Budman, I totally agree with you that we need universal electronic care without it, our health care system will never make the leaps it must in order to dramatically improve care quality, patient safety, clinician satisfaction, patient satisfaction, and transparency/accountability!

Working with physicians in several practice management SW firms in my career I have heard the phrase "I won't do this unless they make it free" for years. While MD behavior and workflow are clearly drivers to adoption, many MD's are simply not interested in spending ANY money on technology. They don't have to use it (in most cases) and would just rather practice medicine. When there is no investment of time or money - there is usually no perceived value, regardless of what product or service is being purchased. CIO's will need to deal with multiple types of adopters (buyers) of technology as we look at EMR roll-outs downstream. Unfortunately, economics (the word FREE) will be at the top of the list of challenges they will face.

Tim and Joe,
Thank you both for your very useful comments and Joe, thank you for the link. I agree, this will continue to be a challenge, as it relates to doctors. And of course it's true that EMRs can't fix everything... Sometimes, I think physicians have unrealistic expectations when it comes to technology... But then again, doesn't everyone...? Thanks again for your very helpful comments.

In the June 10, 2009 issue of Knowledge @ Wharton Health Economics section was this:

Information Technology: Not a Cure for the High Cost of Health Care


The subsection, titled
'Reform Cannot Wait'
described some aspect of the office visit that capture the essence of what doctors think that EMRs cannot fix. Their biggest pain points?

My recent experience...
I went to my GP for a follow up visit after a CAT scan was done. The scan was done on Friday AM, the doc visit was following Tue AM. He had the CAT report, gave me a copy.
He does not have an EMR...all still paper. (As an aside he says he tried an EMR a few yeasr ago and wasted $50k on it before it went bust, it's a 2 doc office).

Then I went to a specialist 2 days latter. He has an EMR, comes into the exam room with his notebook, punches some keys, says I need to get a CAT scan done, last one is way old, I say...had it done last week...here's a copy of the report I got from the GP. He makes a copy.

Oh well...wait till I se my GP again and tell him what happened at the specialist. My doc will love me!